If we could move to a fundamentally different system in which health care would still be delivered through our existing network of providers but would be financed through a single financing mechanism, then the goals articulated by President Obama and by Marmor and colleagues would be more easily achieved.

Much of our health care expense is created by the waste and inefficiency of our balkanized system of public and private programs, each catering to a different “market segment” or “categorically entitled” group. Eliminating this system, and therefore the costs of administering a multitude of private and public programs and the need for marketing, advertising, underwriting, cost allocation, and billing innumerable payers, would go a long way toward cutting costs.